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目的:探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的神经内分泌(NE)分化与临床病理形态学特征及预后因素的关系。方法:手术切除PTC 103例,行HE染色后光镜下观察、免疫组织化学染色后光镜及透射电镜检查、免疫金标记后电镜观察PTC临床病理形态学、光镜及电镜下NE标记(NSE、CgA、Syn)表达及电镜CgA标记的致密核心颗粒表达;分析上述NE标记表达与临床病理参数及预后因素的关系。结果 :PTC表达NSE 64例(62.14%),与肿瘤直径呈正相关(P<0.05);表达CgA25例(24.27%),与肿瘤分化程度呈负相关,与核内包涵体呈正相关(P<0.05);Syn均呈阴性;NSE及CgA共同表达23例(22.33%)。透射电镜PTC致密颗粒检出率为18.2%(12/66);PTC细胞分化程度、肿瘤直径与NE分化有关(P<0.05);免疫金标记电镜观察CgA免疫金颗粒3例(2.91%)。CgA定位于PTC癌细胞胞浆内的NE颗粒边缘呈散在分布。结论:PTC中NE分化细胞可能来源于滤泡上皮细胞;NE分化与PTC瘤体直径、细胞核形态改变及癌细胞分化程度有关,与预后无关。
Objective: To investigate the relationship between neuroendocrine (NE) differentiation and clinical pathomorphology and prognosis in papillary thyroid carcinoma (PTC). Methods: 103 cases of PTC were removed surgically. The specimens were stained by HE staining and observed by light microscopy and transmission electron microscopy. Immunocytochemistry was used to observe the clinicopathological features of PTC. The NE markers (NSE , CgA, Syn) expression and electron microscopy CgA labeled dense core particle expression; analysis of NE marker expression and clinicopathological parameters and prognostic factors. Results: Sixty-four (62.14%) NSE showed positive correlation with tumor diameter (P <0.05), while 25 cases (24.27%) expressed CgA negatively correlated with the degree of tumor differentiation and positive correlation with nuclear inclusion (P <0.05) ); Syn were negative; NSE and CgA co-expression in 23 cases (22.33%). Transmission electron microscopy was used to detect the density of dense particles of PTC (18.2%, 12/66). The differentiation degree of PTC cells and the diameter of tumor were related to the differentiation of NE (P <0.05). Immuno gold electron microscopy showed CgA immunogold particles in 3 cases (2.91%). CgA localized in the cytoplasm of PTC cancer cells NE particles scattered edge distribution. CONCLUSION: The NE-differentiated cells in PTC may originate from the follicular epithelial cells. NE differentiation is related to the diameter of tumor, the change of nuclear morphology and the degree of differentiation of cancer cells, but not to prognosis.